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Discussion of palliative sedation at end of life (Franklin Hospital Hospice Unit, NSLIJHealth System & Hospice Care Network of L.I.)

Dr. Desiree Pardi, a leading practitioner in palliative care, counseled patients about accepting death, until cancer spread in her body, and she chose to fight it.

Palliative care program at Montefiore Hospital

Startup cost & shortage of palliative MDs.

Most readers favor palliative sedation if its primary intent is to allay intolerable suffering even if it may accelerate dying - as opposed to allowing the suffering because its treatment may lead to an earlier death.

Even when the system works as it's supposed to, and palliative care specialists arrive like the cavalry to provide comfort care, to stop fruitless and painful interventions and to support what patients want, their own colleagues may brand them murderers. It takes strong doctors to stand up to that kind of verbal abuse, to explain that courts and ethics committees have approved care that's intended to reduce suffering, to point out that the patient's own wishes are paramount. Perhaps they have to be stronger than we know. "The culture is changing," Dr. Matlock told me. "But it's not changed yet."

letters re Montefiore palliative program description in NYTimes

The researchers found that in areas where end-of-life care costs were normally high, having an advance directive significantly lowered the cost of care. On average, end-of-life care spending was $5,585 less per person in the high-spending regions when someone had an advance directive. > Having an advance directive didn't necessarily limit the initiation of aggressive treatments, but seemed to lead to their earlier withdrawal. Author said this finding was particularly important because some people make the argument that having an advance directive might limit all of the care you receive at the end of your life. But, this finding shows that while treatments are often started, for "patients with an advance directive, there's an earlier recognition of when treatments aren't working and when it's time to go to hospice."

Readers largely support measures to allow death in dignified environment with palliative approach, as opposed to repeated aggressive interventions that are rarely successful when the prognosis is poor.

NYH palliativist fights for her own life to the end